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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Abridged version. Can Urol Assoc J 2021; 15:383-393. [PMID: 34847343 PMCID: PMC8631858 DOI: 10.5489/cuaj.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Full-text. Can Urol Assoc J 2021; 15:E676-E690. [PMID: 34464257 PMCID: PMC8631842 DOI: 10.5489/cuaj.7581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Bhojani N, Andonian S, Watterson JD, Dushinski JW, Shayegan B, Schuler TD, Pace KT, Chew BH, Razvi H. Canadian Urological Association best practice report: Holmium:YAG laser eye safety. Can Urol Assoc J 2020; 14:380-382. [PMID: 33259283 DOI: 10.5489/cuaj.6941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, QC, Canada
| | - Sero Andonian
- Division of Urology, McGill University, Montreal, QC, Canada
| | - James D Watterson
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - John W Dushinski
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Trevor D Schuler
- Divison of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kenneth T Pace
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hassan Razvi
- Division of Urology, Western University, London, ON, Canada
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Lavoie CA, Levine M, Schuler TD, Wollin TA, De S. Understanding failures in getting it up: The prevalence and predictors of failed ureteral access in ureteroscopy. Can Urol Assoc J 2020; 15:E135-E138. [PMID: 32807285 DOI: 10.5489/cuaj.6059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Failed access ureteroscopy (FA) describes the inability to gain adequate access to a stone to allow for treatment. The purpose of this study was to identify the prevalence of, and factors predicting FA in patients presenting with renal and ureteral stones. METHODS We conducted a retrospective review of all ureteroscopy (URS) procedures performed for renal and ureteral stones by three endourologists over a six-month period at our center. All patients who underwent URS for the purpose of stone treatment were included. Patients were excluded if they underwent URS for non-stone diagnosis or treatment. FA was investigated in relation to demographics, medical history, stone-specific characteristics, procedure-specific characteristics, etc. Statistical analysis consisted of descriptive statistics, as well as Chi-squared and t-test analysis using SPSS statistical software version 24.0. RESULTS A total of 188 cases were reviewed, with 8% of patients experiencing FA. Patient age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, emergency cases, previous stone treatment, use of computed tomography (CT) imaging, presence of hydronephrosis, and surgeon did not differ significantly between FA and successful access (SA) groups. Stone size (9.88±5.8 vs. 8.76±4.3 mm; p=0.361) was also not significantly different. However, a significant difference was noted in time from first diagnosis to URS (128 vs. 65 days, p=0.044) between the FA and SA groups, respectively. Similarly, for ureteral stones, the FA group had a significantly greater proportion of stones located in the proximal ureter (62.5% vs. 22.0%, p=0.043). CONCLUSIONS Proximal ureteric stones were more likely to result in FA URS, and FA procedures were more likely to be preceded by extended time from first diagnosis to URS. Further investigation is necessary, and all endourology centers should track their own personal outcome data to allow for more meaningful analysis to be performed to improve patient outcomes.
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Affiliation(s)
- Callum A Lavoie
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Max Levine
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Trevor D Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Timothy A Wollin
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Assmus MA, De S, Schuler TD, Bochinski D, Wollin TA. The “Acute” Stone Clinic Effect: Improving Healthcare Delivery by Reorganizing Clinical Resources. J Endourol 2017; 31:1096-1100. [DOI: 10.1089/end.2017.0332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mark A. Assmus
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Derek Bochinski
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy A. Wollin
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Hoy NY, Shapka L, Rudzinski J, Schuler TD, Wollin TA, Bochinski D, De SK. Are We Banging Our Heads Against the Wall? The Effect of Treatment Head Wear on the Outcomes of Extracorporeal Shockwave Lithotripsy. J Endourol 2016; 30:1017-21. [PMID: 27405967 DOI: 10.1089/end.2016.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE The manufacturer for the Storz Modulith SLX-F2 lithotripter recommends treatment head exchange after 1.65 million shocks. However, there is no documentation describing longevity of the treatment head with continued usage. The objective of this study is to determine whether there is a difference in stone fragmentation effectiveness with the treatment head at the beginning versus the end of its treatment life. METHODS We conducted a retrospective chart review of 200 patients-50 consecutive patients treated immediately preceding, and following, two separate treatment head exchanges. Primary outcome measures were stone-free rate (no stone), total stone fragmentation (any decrease in size), and fragmentation rate ≤4 mm (decrease in size with largest residual fragment ≤4 mm), based on most recent follow-up imaging post shockwave. RESULTS There were no baseline characteristic differences between the pre-exchange and postexchange groups with respect to first time lithotripsy for the stone (85% vs. 77%), stone location, preoperative stenting (3% vs. 4%), mean stone density (912 hounsfield units [HU] vs. 840 HU), mean stone size (9.0 mm vs. 8.1 mm), stone location, and mean number of shocks delivered (3105 vs. 3089). Mean time to follow-up was 2.7 weeks in both groups, with most follow-up imaging consisting of a kidney ureter bladder X-ray (87% pre-exchange vs. 85% postexchange). Stone free (34% vs. 27%), total stone fragmentation (76% vs. 76%), fragmentation ≤4 mm (48% vs. 42%), re-treatment rates (38% vs. 51%), and complication rates (6% vs. 7%), were not statistically different between the pre and postexchange groups, respectively. CONCLUSIONS Exchanging the Storz Modulith F2 lithotripter head at the manufacturer recommended 1.65 million shocks does not affect the stone-free or fragmentation rate. If the manufacturer's recommendation for treatment head longevity is based on clinical outcomes, then there is likely room to extend this number without affecting treatment efficacy.
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Affiliation(s)
- Nathan Y Hoy
- Division of Urology, University of Alberta , Edmonton, Canada
| | - Larissa Shapka
- Division of Urology, University of Alberta , Edmonton, Canada
| | - Jan Rudzinski
- Division of Urology, University of Alberta , Edmonton, Canada
| | | | | | - Derek Bochinski
- Division of Urology, University of Alberta , Edmonton, Canada
| | - Shubha K De
- Division of Urology, University of Alberta , Edmonton, Canada
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Ordon M, Schuler TD, Ghiculete D, Pace KT, Honey RJD. Stones lodge at three sites of anatomic narrowing in the ureter: clinical fact or fiction? J Endourol 2012; 27:270-6. [PMID: 22984899 DOI: 10.1089/end.2012.0201] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Abstract Background and Purpose: Throughout the literature, the ureter is described as having three anatomic sites of narrowing at which kidney stones typically become lodged: The ureteropelvic junction (UPJ), the ureteral crossing of the iliac vessels, and the ureterovesical junction (UVJ). There is little evidence to support this notion, however. The purpose of our study is to evaluate whether three peaks in stone distribution corresponding to these anatomic landmarks exist. METHODS We retrospectively reviewed the kidneys-ureters-bladder (KUB) films of 622 patients with solitary ureteral calculi referred for shockwave lithotripsy (SWL). Pretreatment KUB films were used to categorize the location of their ureteral stone relative to 1 of 19 levels referenced to the axial skeleton. CT scans of 74 patients were used to determine the location of the UPJ, ureteral crossing of the iliac vessels, and UVJ relative to the 19 levels on KUB radiography. Histograms were then constructed to plot the distribution of stones within the ureter relative to these 19 levels. The effect of sex, stone size and side, and presence of a stent on stone distribution were analyzed. RESULTS There are two peaks in the distribution of stones within the ureter in patients referred for SWL that correspond to the UPJ/proximal ureter and intramural ureter/UVJ. In patients with larger stones (≥100 mm(2)) or a ureteral stent in place, stones were distributed more proximally (P<0.0001). When comparing sexes, there was a difference in stone distribution that approached significance (P=0.0523), with a greater peak more distally in males compared with females. CONCLUSIONS Our review demonstrates a peak in the distribution of stones corresponding to the UPJ/proximal ureter and the intramural ureter/UVJ. We failed to demonstrate a peak in stone distribution corresponding with the ureteral crossing of the iliac vessels.
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Affiliation(s)
- Michael Ordon
- Division of Urology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Ordon M, Schuler TD, Honey RJ. Ureteral avulsion during contemporary ureteroscopic stone management: "the scabbard avulsion". Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000500015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Ureteral avulsion during ureteroscopic stone management is extremely rare. To date, many publications reporting avulsion have been associated with "blind basket extraction" under fluoroscopy and the use of the Dormia stone basket. Fortunately, despite the significant rise in the numbers of ureteroscopic cases being performed, the rate of ureteral avulsion remains low. This is likely in part because of improvements in ureteroscope technology and stone manipulation devices. We present three recent cases of ureteral avulsion referred to our center for further management. To our knowledge, these cases represent the first published description of avulsion where the ureteroscope became wedged in the intramural ureter, resulting in full-length avulsion of the ureter. The avulsion occurs both proximally and distally with a resultant length of ureter left attached to the ureteroscope. We dub this mechanism the "scabbard" avulsion. We describe the most likely mechanism of this injury, with suggestions on how to prevent it and how to release the ureteroscope should it become wedged in the intramural ureter.
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Affiliation(s)
- Michael Ordon
- Division of Urology, St. Michael's Hospital , Toronto, Ontario, Canada
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Wiesenthal JD, Schuler TD, Honey RJD, Pace KT. Predictors of health-related quality of life recovery following laparoscopic simple, radical and donor nephrectomy. BJU Int 2010; 107:636-41. [DOI: 10.1111/j.1464-410x.2010.09571.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schuler TD, Shahani R, Honey RJD, Pace KT. Medical Expulsive Therapy as an Adjunct to Improve Shockwave Lithotripsy Outcomes: A Systematic Review and Meta-Analysis. J Endourol 2009; 23:387-93. [DOI: 10.1089/end.2008.0216] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Schuler TD, Perks AE, Fazio LM, Blew BD, Mazer D, Hare G, Honey RJD, Pace KT. Impact of Arterial and Arteriovenous Renal Clamping with and without Intrarenal Cooling on Renal Oxygenation and Temperature in a Porcine Model. J Endourol 2008; 22:2367-72. [DOI: 10.1089/end.2008.9710] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
| | - Alexandra E. Perks
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
| | - Luke M. Fazio
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
| | - Brian D.M. Blew
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
| | - David Mazer
- Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Toronto Ontario, Canada
| | - Greg Hare
- Department of Anaesthesia, St. Michael's Hospital, University of Toronto, Toronto Ontario, Canada
| | - R. John D'A. Honey
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
| | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto Ontario, Canada
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Perks AE, Schuler TD, Lee J, Ghiculete D, Chung DG, D'A Honey RJ, Pace KT. Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 2008. [PMID: 18674803 DOI: 10.1016/j.urology.2008.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine whether stone attenuation and the skin-to-stone distance (SSD) can predict for stone fragmentation by SWL independently. Identifying the factors predictive of shock wave lithotripsy (SWL) outcome would help streamline the care of patients with stones. METHODS A retrospective review was performed of 111 patients undergoing initial SWL for a solitary, 5-20 mm, renal calculus. Stone size, location, attenuation value, and SSD were determined on pretreatment noncontrast computed tomography. The outcome was categorized as stone free, complete fragmentation <5 mm, and incomplete fragmentation >or=5 mm or unchanged at 2 weeks on kidney/ureter/bladder radiography. RESULTS After SWL, 44 (40%) were stone free, 27 (24%) had complete fragmentation, and 40 (36%) of 111 patients had incomplete fragmentation. The stone attenuation of the successfully treated patients (stone free and complete fragmentation groups) was 837 +/- 277 Hounsfield units (HU) vs 1092 +/- 254 HU for those with treatment failure (incomplete fragmentation; P < .01). The mean SSD also differed: 9.6 cm +/- 2.0 vs 11.1 cm +/- 2.5 for the successful treatment group vs the treatment failure group, respectively (P = .01). On multivariate analysis, the factors that independently predicted the outcome were stone attenuation, SSD, and stone composition. When patients were stratified into 4 risk groups (stone <900 HU and SSD <9.0 cm, stone <900 HU and SSD >or=9.0 cm, stone >or=900 HU and SSD <9.0 cm, and stone >or=900 HU and SSD >or=9.0 cm), the SWL success rate was 91%, 79%, 58%, and 41%, respectively (odds ratio 7.1, 95% confidence interval 1.6-32 for <900 HU and SSD <9.0 cm group vs other 3 risk groups; P = .01). CONCLUSIONS The results of our study have shown that a stone attenuation of <900 HU, SSD of <9 cm, and stone composition predict for SWL success, independent of stone size, location, and body mass index. These factors will be considered important in the prospective design of a SWL treatment nomogram at our center.
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Affiliation(s)
- Alexandra E Perks
- Division of Urology, Department of Surgery, and the Department of Radiology, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Perks AE, Schuler TD, Pace K, Honey RJ. Prospective Determination of Ureteral Orifice Location: A Guide for Fluoroscopic Ureteral Stent Insertion. J Endourol 2008; 22:1203-7. [DOI: 10.1089/end.2008.0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexandra E. Perks
- Department of Urology, University of Toronto, Toronto, British Columbia, Canada
| | - Trevor D. Schuler
- Department of Urology, University of Toronto, Toronto, British Columbia, Canada
| | - Kenneth Pace
- Department of Urology, University of Toronto, Toronto, British Columbia, Canada
| | - R. John Honey
- Department of Urology, University of Toronto, Toronto, British Columbia, Canada
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Schuler TD, Hasan M, Stewart R, Honey RJ, Pace KT. LONG-TERM HEALTH RELATED QUALITY OF LIFE FOLLOWING LAPAROSCOPIC AND OPEN DONOR NEPHRECTOMY. J Urol 2008. [DOI: 10.1016/s0022-5347(08)62037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Perks AE, Schuler TD, Pace KT, Honey RJ. 1697: Prospective Determination of Ureteric Orifice Location - A Guide for Fluoroscopic Stent Insertion. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schuler TD, Ghiculete D, Pace KT, Perks AE, Honey RJ. 1371: Stones Lodge at 3 Sites of Anatomic Narrowing in the Ureter - Clinical Fact or Fiction? J Urol 2007. [DOI: 10.1016/s0022-5347(18)31585-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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